87R9723 LHC-F
  By: Price H.B. No. 2117
  relating to the prescribing of controlled substances and dangerous
  drugs for acute pain.
         SECTION 1.  Subtitle A, Title 3, Occupations Code, is
  amended by adding Chapter 107A to read as follows:
         Sec. 107A.001.  DEFINITIONS. In this chapter:
               (1)  "Abuse" or "substance abuse" means the maladaptive
  pattern of substance use manifested by recurrent and significant
  adverse consequences related to the repeated use of controlled
  substances or other drugs.
               (2)  "Acute pain" means the normal, predicted,
  physiological response to a stimulus such as trauma, disease, and
  operative procedures.  Acute pain is time limited.  The term does
  not include:
                     (A)  chronic pain;
                     (B)  pain being treated as part of cancer care;
                     (C)  pain being treated as part of hospice or
  other end-of-life care; or
                     (D)  pain being treated as part of palliative
               (3)  "Addiction" means a primary, chronic, or
  neurobiological disease characterized by craving and compulsive
  use of drugs. Addiction is often characterized by impaired control
  over drug use, including taking more drugs more often than
  prescribed by a physician. It may also be characterized by
  continued use despite harm to oneself or others. Genetic,
  psychosocial, and environmental factors may influence the
  development and manifestation of addiction. Physical dependence
  and tolerance are normal physiological consequences of extended
  drug therapy for pain and, alone, do not indicate addiction.
               (4)  "Chronic pain" means a state in which pain
  persists beyond the usual course of an acute disease or healing of
  an injury. Chronic pain may be associated with a chronic
  pathological process that causes continuous or intermittent pain
  over months or years.
               (5)  "Controlled substance" has the meaning assigned by
  Section 481.002, Health and Safety Code.
               (6)  "Dangerous drug" has the meaning assigned by
  Section 483.001, Health and Safety Code.
               (7)  "Diversion" means the use of drugs by anyone other
  than the person for whom the drug was prescribed.
               (8)  "Pain" means an unpleasant sensory and emotional
  experience associated with actual or potential tissue damage.
               (9)  "Physical dependence" means a state of adaptation
  that is manifested by drug class-specific signs and symptoms that
  can be produced by abrupt cessation, rapid dose reduction,
  decreasing blood level of the drug, or administration of an
               (10)  "Practitioner" means a person, other than a
  veterinarian, authorized to prescribe a controlled substance.
               (11)  "Tolerance" means a physiological state
  resulting from regular use of a drug in which an increased dosage is
  needed to produce a specific effect or in which a reduced effect is
  observed with a constant dose over time. Tolerance does not
  necessarily occur during opioid treatment and does not, alone,
  indicate addiction.
               (12)  "Withdrawal" means the physiological and mental
  readjustment that accompanies discontinuation of a drug for which a
  person has established a physical dependency.
         Sec. 107A.002.  EVALUATION OF PATIENT WITH ACUTE PAIN. (a)  
  A practitioner's treatment of a patient's acute pain is evaluated by
  considering whether the treatment meets the generally accepted
  standard of care.
         (b)  A practitioner shall obtain a medical history and a
  physical examination that includes a problem-focused examination
  specific to the chief presenting complaint of the patient.  The
  patient's medical record must document the medical history and
  physical examination.
         (c)  The Texas Medical Board shall adopt rules governing what
  information a practitioner who is prescribing a controlled
  substance or dangerous drug for acute pain or creating a treatment
  plan for the treatment of acute pain must place in the patient's
  medical record regarding the medical history and physical
  examination of the patient. The rules adopted under this
  subsection may create different standards for practitioners
  treating patients with acute pain in an emergency department.
         (d)  Before prescribing a controlled substance or dangerous
  drug for the treatment of acute pain, a practitioner must review
  prescription data and history related to the patient under Section
  481.076, Health and Safety Code.
         (e)  If a practitioner determines that reviewing the
  patient's prescription data and history under Subsection (d) is not
  necessary before prescribing a controlled substance or dangerous
  drug to the patient, the practitioner must document in the
  patient's medical record the practitioner's rationale for not
  reviewing the data and history.
         Sec. 107A.003.  INFORMED CONSENT. (a) Each regulatory
  agency that issues a license, certification, or registration to a
  practitioner shall create specific written guidelines for a
  discussion between the practitioner and a patient with acute pain,
  or the patient's surrogate or guardian if the patient is unable to
  give consent for the patient's medical treatment, about the risks
  and benefits of the use of a controlled substance or dangerous drug
  to treat the patient's acute pain.
         (b)  The written guidelines must require that the
               (1)  be verbal;
               (2)  except as provided by Subsection (c), be completed
  before the prescription is issued;
               (3)  be documented by a signed document maintained in
  the patient's medical record or a contemporaneous notation included
  in the patient's medical record; and
               (4)  include an explanation of:
                     (A)  the risk of addiction associated with the
  drug prescribed, including any risk of developing an addiction or a
  physical or psychological dependence on the drug;
                     (B)  the risk of taking the drug in a dosage
  greater than the dosage prescribed;
                     (C)  the danger of taking the drug with
  benzodiazepines, alcohol, or other central nervous system
                     (D)  the reasons why the prescription is
                     (E)  the responsibility of the patient to
  safeguard all drugs in a secure location;
                     (F)  methods for safely disposing of an unused
  portion of a controlled substance or dangerous drug prescription;
                     (G)  the patient's diagnosis;
                     (H)  the proposed treatment plan;
                     (I)  any anticipated therapeutic results,
  including realistic expectations for sustained pain relief and
  improved functioning and possibilities for lack of pain relief;
                     (J)  therapies available in addition to or instead
  of drug therapy, including non-pharmacological therapeutic
  modalities or psychological techniques;
                     (K)  potential side effects and techniques for
  managing the side effects;
                     (L)  possible adverse effects, including the
  potential for tolerance and withdrawal; and
                     (M)  the potential for impairment of judgment and
  motor skills.
         (c)  In the case of prescribing a controlled substance or
  dangerous drug to a patient for acute pain following surgery, the
  written guidelines must:
               (1)  allow the practitioner to discuss the information
  described by Subsection (b)(4) with the patient at different phases
  of the healing process, at the time when receiving that information
  would be most effective, regardless of whether some or all of the
  information is discussed with the patient after the prescription is
  issued and the patient has begun taking the controlled substance or
  dangerous drug;
               (2)  provide recommendations as to when each piece of
  information described by Subsection (b)(4) should be discussed with
  the surgical patient;
               (3)  allow the practitioner to determine when each
  explanation described by Subsection (b)(4) should occur, based on
  the patient's best interest; and  
               (4)  allow the practitioner to delegate to a licensed
  physician assistant, nurse practitioner, or registered nurse any
  explanation described by Subsection (b)(4).
         (d)  A regulatory agency described by Subsection (a) may
  develop written guidelines for written information to be provided
  to the patient about the risks and benefits of a controlled
  substance or dangerous drug used to treat the patient's acute pain.
  The guidelines may not authorize the practitioner to provide the
  written information under this subsection in lieu of discussing the
  information verbally with the patient as described by Subsection
  CONSULTATION AND REFERRAL. (a)  If necessary, the practitioner
               (1)  see the patient being treated for acute pain for
  periodic review at reasonable intervals; or
               (2)  subject to Subsection (c), refer the patient to
  another practitioner for further evaluation and treatment.
         (b)  The practitioner shall review the patient's compliance
  with the prescribed treatment plan and reevaluate the potential for
  substance abuse or diversion.
         (c)  Patients who are at risk for substance abuse or
  addiction and patients with acute pain and histories of substance
  abuse or addiction or with comorbid psychiatric disorders require
  the consideration of a consultation with or referral to an expert in
  the management of those patients.
         SECTION 2.  The Texas Medical Board shall adopt and
  implement the rules described by Section 107A.002(c), Occupations
  Code, as added by this Act, not later than March 1, 2022.
         SECTION 3.  Each regulatory agency that issues a license,
  certification, or registration to a practitioner as defined by
  Section 107A.001, Occupations Code, as added by this Act, shall
  create and make available to the practitioner the specific written
  discussion guidelines required by Section 107A.003, Occupations
  Code, as added by this Act, not later than March 1, 2022.
         SECTION 4.  The change in law made by this Act applies only
  to a prescription issued on or after March 1, 2022. A prescription
  issued before that date is governed by the law in effect immediately
  before March 1, 2022, and the former law is continued in effect for
  that purpose.
         SECTION 5.  This Act takes effect September 1, 2021.